Symptoms of post-cholecystectomy syndrome

Cholecystectomy is a common surgical operation, with good results in most patients. However, in a small number of patients, the original symptoms persist or reappearance of upper abdominal discomfort, dull pain, indigestion and other symptoms after cholecystectomy. This is often referred to clinically as post-cholecystectomy syndrome. Most scholars believe that it occurs 1, 5 to 6 years after surgery, while some scholars believe that it can occur at any time after surgery, and the reasons are more complicated.

Clinical manifestations:

Half of PCS patients experience abdominal pain or "dyspepsia" (fullness in the upper or right upper abdomen, borborygmus, nausea, vomiting, constipation, fat intolerance, or diarrhea) within a few weeks after surgery, while the other half experience symptoms months or years after surgery. These symptoms are nonspecific and vary depending on the underlying cause, but often include pain in the right upper abdomen or epigastrium, which is often sharp after meals.

Other symptoms may include heartburn, belching, vomiting, and intolerance to fatty foods. A few patients may have severe cholecystitis or pancreatitis, with severe pain and possibly fever, jaundice, or vomiting. Examination of such patients is more likely to reveal a specific disorder than that of patients with mild or no specific symptoms. Physical examination is usually of no particular value except for the detection of obvious jaundice.

complication:

1. Other comorbidities

Nearly 1/3 of patients did not undergo a detailed examination before cholecystectomy, and some symptoms were ignored and only diagnosed as gallbladder disease, and then cholecystectomy was performed. The common ones are as follows: (1) reflux esophagitis, hiatal hernia; (2) gastric diseases such as gastric ulcer and gastritis; (3) duodenal lesions such as papillitis and parapapillary diverticulum; (4) pancreatic diseases such as chronic pancreatitis and tumors. First of all, they should be differentiated. As long as the possibility of these diseases is considered, the relevant medical history should be carefully inquired and relevant examinations should be performed, such as CI, gastrointestinal endoscopy, B-ultrasound, CT, etc.

2. Biliary tract motility disorder

Under normal circumstances, the smooth muscle of the bile duct is regulated by nerves and humors, and gastrointestinal hormones and nerve impulses work together to harmoniously regulate the contraction and relaxation of different parts of the bile duct. For example, after eating, the gallbladder smooth muscle contracts and the Oddi sphincter relaxes, thereby promoting bile to enter the duodenum and participate in digestion. After cholecystectomy, this balance is disrupted. Most patients are able to adapt and compensate for this balance through neurohumoral mechanisms.

A few patients have difficulty adapting. Some examinations have found that the pressure of the Oddi sphincter increases and the frequency of contraction increases. After eating, the secretion of gastrointestinal hormones cannot be inhibited by feedback and increases, causing abnormal contraction or spasm of the bile duct smooth muscle, resulting in abdominal pain. The symptoms of such patients will disappear after taking oral anti-inflammatory and choleretic drugs.

3. Residual stones in the common bile duct

The main reason is missed diagnosis before surgery, followed by gallstones sliding into the common bile duct or intrahepatic stones being discharged into the common bile duct during the operation. If the common bile duct stones are not found before or during surgery, and patients develop biliary colic accompanied by jaundice, fever, and Chancut's triad after surgery, the best diagnostic methods are MRCP and ERCP. Once confirmed, the best method is endoscopic papillotomy (EST) to remove the stones, otherwise another surgery is required.